Residency Fair Form

Home
Residency Fair Form

Residency Fair Form

Friday, April 17, 2020
10:00AM - 1:00PM
Burrell College of Osteopathic Medicine Lobby Area

Lunch will be provided.

Please RSVP by April 9th, 2020

There is no required fee for attending or hosting a booth.
Please fill out the form below for each of the attendees:

Name:*
(Suffix: MD, DO, etc)
First Last Suffix
Phone:*
Email:*
Enter Email Confirm Email
Name of Institution:*
Location of Institution:*
Speciality:*
Number of People Attending:*
Do you have any dietary restrictions?*

For any questions, please contact:

Michelle Devora, MEd
Director of Career Development, Office of Student Affairs
mdevora@burrell.edu
(575) 674-2228

X

X